PROJECT SUMMARY African Americans are 50% more likely to develop Alzheimer?s disease than white Americans. Understanding disparities in Alzheimer?s disease and related dementias (ADRD) is an important public health issue, but few studies are designed to allow for a robust evaluation of ADRD-related health outcomes stratified by race and social risk factors. The Southern Community Cohort Study (SCCS) is a unique resource because it was launched to investigate health disparities related to cancer and other conditions in an understudied population. This longitudinal study recruited 86,000 adults age 40-79 between the years 2002-2009 in 12 Southern states. Two thirds of the study population is African American. About 9,300 SCCS participants are currently alive and age 75 and older. Another 2,300 SCCS participants have died after reaching age 75. Almost all SCCS participants over age 65 are enrolled in Medicare. Thus, claims-based measures of health care use and diagnostic information are almost universally available for these older SCCS members. Accordingly, we can identify ADRD and cognitive impairment through administrative data sources that are linked to the self-reported measures from the SCCS baseline survey and four follow-up surveys. This project will link additional administrative data sources on hospice and nursing home use to SCCS survey data. These new data sources and previously linked Medicare claims will be used to analyze how the incidence and prevalence of ADRD and cognitive impairment varies by race and social risk factors within the SCCS older population. We will also examine how hospital utilization and access to specialists varies by race and social risk factors for SCCS participants with ADRD or cognitive impairment. By examining these research questions, this study will provide a better understanding of health care disparities related to ADRD and lay the groundwork for future SCCS-based studies in this important area.